Attachment 03 - SCI Cough Assist Policy.pdf

VA SAN DIEGO HEALTHCARE SYSTEM SPINAL CORD INJURY UNIT

SAN DIEGO, CA UNIT BASED POLICY 128N-150.02

March 15th 2021

COUGH-ASSIST®/OTHER INEXSUFFILATOR FOR PATIENTS

WITH SPINAL CORD INJURY/DISEASE (SCI/D)

1. PURPOSE:

a. To establish a procedure for clearing retained bronchopulmonary secretions using the Cough-Assist® device.

2. POLICY:

a. Indications: Any SCI/D patient, trached or non-invasively ventilated or who is unable to effectively clear secretions due to reduced peak cough expiratory flow (less than 5-6 liters per sec). Etiologies include neuromuscular deficits and severe fatigue associated with intrinsic lung disease.

b. Contraindications: Patients with a history of bullous emphysema, susceptibility to pneumothorax or pneumo-mediastinum, recent trauma to chest (i.e. rib fractures or flail chest).

(a) Caution: Patients known to have cardiac instability are monitored for pulse and oxygen saturation during the procedure.

(b) Caution: Patients using Cough-Assist® for first time may experience pain/soreness from a pulled muscle secondary to positive pressures exceeding patient’s normal pressure. These patients should start at a lower positive pressure and gradually increase positive pressures used.

(c) Do not use in presence of flammable anesthetics.

(d) Do not store device in a place where it can fall or be a trip hazard.

3. DEFINITIONS:

a. Inexsuffilator (“Cough Assist”): An inexsuffilator machine that provides mechanical inspiration and forced expiration (cough) for patients lacking voluntary control of their coughing muscles.

4. RESPONSIBILITIES:

a. SCI Physician, Physician Assistant, Respiratory Therapists, SCI RNs, LVNs, SNTs, GNTs, VALORS: use Cough Assist® for SCI patients after completing education and training.

b. SCI Physician/ Pulmonary Physicians: provide an order for Cough Assist® before use on patient. The order must specify inspiratory and expiratory

SAN DIEGO, CA UNIT BASED POLICY 128N-150.02

pressure limit ranges, frequency of treatment, and mode of administration (automatic/manual).

c. Respiratory Therapists (RT): who are trained in the use of CoughAssist® delivers and set ups the machine in accordance with manufacturer’s guidelines. The RT works with the provider to establish initial settings or changes and assure the settings are documented in CPRS, posted at bedside and placed in patient’s nursing care binder using CoughAssist Settings worksheet (see Attachment A).

d. SCI RNs, LVNs, GNTs, SNEs, SNTs and VALORS: who are trained in the CoughAssist® are responsible for performing subsequent treatments according to the settings established by the RT and provider observing patient responses, and documenting treatments.

e. Logistics: disposable supplies including “blow-by” tubing, filters, trach adaptors, and disposable face masks.

5. PROCEDURES:

a. Initial Set Up of inexsuffilator will be done by RT therapy will be provided by trained staff according to manufacturers recommendations.

6. REFERENCES:

a. Bach, JR (2012). Noninvasive respiratory management of high level spinal cord injury Journal of Spinal Cord Medicine, 35( 2) 72-80(9).

b. Cough Assist for Effective Airway Clearance Therapy. RT: The Journal for Respiratory Care Practitioners. 2019; 32(1):12-19. Accessed February 19, 2021.

http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=13463886 5&site=ehost-live

c. Berlowitz, D.; Wadsworth, B.; Ross, J. (2016). Respiratory problems and management in people with spinal cord injury. Breathe (Sheff). 12(4), 328-

340. doi: 10.1183/20734735.012616.

d. Kan, A.; Butler, J.; Hutchence, M.; Jones, K.; (2018). Teaching Manually Assisted Cough to Caregivers of Children With Neuromuscular Disease.

Respir Care, 63(12), 1520-1527. doi: 10.4187/respcare.06213.

e. Kim, S.; Choi, W.; Won, Y.; Kang, S. (2016). A Comparison of Cough

Assistance Techniques in Patients with Respiratory Muscle Weakness.

Yonsei Medical Journal. 57(6):1488-93. doi: 10.3349/ymj.2016.57.6.1488.

http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=134638865&site=ehost-live http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=134638865&site=ehost-live

SAN DIEGO, CA UNIT BASED POLICY 128N-150.02

f. Hess, DR (2012). The Growing Role of Noninvasive Ventilation in Patients Requiring Prolonged Mechanical Ventilation. Respiratory Care, 57(6): 900- 920(21).

g. Racca, F.; Vianello, A.; Mongini, T.; Ruggeri, P.; Versaci, A. (2020).

Practical approach to respiratory emergencies in neurological diseases.

Neurology Science, 41(3):497-508. doi: 10.1007/s10072-019-04163-0.

7. REVIEW DATE:

a. March 2024

8. FOLLOW-UP RESPONSIBILITY:

a. SCI Clinical Nurse Specialist

9. RESCISSION:

a. Spinal Cord Injury Unit Based Policy 128N-150.02 titled, “CoughAssist™ For

Patients with SCI/D,” dated November 2016.

10. SIGNATURE:

X Elaine Minsch, MSN, RN Nurse Manager of Spinal Cord Injury

Attachment: A Distribution: SharePoint

VA SAN DIEGO HEALTHCARE SYSTEM SPINAL CORD IINJURY CENTER

SAN DIEGO, CA UNIT BASED POLICY

Attachment A SCI NURSING P&P 128N-150.02

Cough Assist Settings Worksheet

COUGH ASSIST SETTINGS FOR: _______________

Check Settings Prior to Each Therapy Session

Inhale/Positive Pressure:___________________

Inhale Time: ___________________

Exhale/Negative Pressure:__________________

Exhale Time: ________________

Inhale Flow Setting (HIGH or LOW): ____________

Pause Time: _______________

Document these settings and any changes in a progress note.

Keep these settings posted @ bedside and nursing binder